Posted by DrTucker in Articles by Dr. Tucker, Blog, Core training, Fitness & Exercise, Rehab Exercises on 02 23rd, 2012 | no responses
Here’s a link to an article on golfing I wrote in Dynamic Chiropractic magazine:
Jeff.. I’ve always been taught to have pt do a pelvic tilt and then squeeze the butt while in this position..before bridging… Is this incorrect?
From the hook lying position, maintain the abdominal brace in order to keep your spine stable.
Have your arms at your side and turn them out so that the back of your thumbs are pressed against the floor. Spread your fingers out as wide as possible.
Keep the spine in a neutral position and slowly raise your pelvis off the floor into the bridge position (at this point you can have the client pre-contract the glutes). I like to observe what strategy they use without coaching on the first several reps. Do they use more hamstrings vs glutes?
Be sure to maintain the abdominal brace throughout the entire movement.
It is also important not to let your low back arch or flatten out at any time during the movement.
Slowly lower back to the starting position.
If getting the spine in a neutral position requires slight pelvic tilt, by all means explore APT or PPT and help them find it. You’ll be amazed at how many low back clients have lost the ability to perform ATP and PPT. Also make sure the knees stay in neutral as well (they don’t drift inward or outward).
Additional bridge progression
Cook Bridge (Hold one knee to chest)
Bridge with strap around the knees
Bridge with heels raised
Bridge with steps
Bridge with one leg extended
Hope this helps.
Posted by DrTucker in Articles by Dr. Tucker, Daily Exercises, Fitness & Exercise, Rehab Exercises, Shoulder on 12 7th, 2011 | no responses
To Your Health December, 2011 (Vol. 05, Issue 12) Share | By Jeffrey Tucker, DC, DACRB
The most common injury sites for golfers are the low back, shoulder, knee, elbow and wrist. Golfers who have low back pain demonstrate a decrease in range of motion for hip internal rotation on the lead leg (left leg for a right-handed golfer) and lumbar extension, and decreased activation and/or timing of the abdominal obliques, erector spinae and knee extensors. A good golf swing uses the left side of the body as much as the right. The hips initiate movement into the ball. The feet pushing against the ground cause a ground reaction force that sequentially travels up through the hips, the trunk and finally out the arms. The most noticeable difference between pros and amateurs is trunk rotation. Trunk rotation and flexibility are enormously important in golf. Older and less skilled players tend to use less than half the trunk rotation of younger or more skilled players.
Golfers who are looking to maximize their performance and avoid and/or rehabilitate following common golf-related injuries should try these exercises in consultation with their doctor of chiropractic:
Active Warm-Up Exercises Bend forward at the hips to touch the fingers to the floor.
Step into a stride position, extending the right leg (lunge).
Lift the right arm, rotate the spine and the head – hold this pose for 10 seconds.
Return to the stride position.
With hands on the left thigh, drop the back knee toward the floor and reach both arms overhead.
Twist the torso toward flexed front knee and hold.
Return to the hip flexor stretch position then put both hands on the floor.
Go to push-up position.
Sweep the left foot across in front – sit into the stretch and hold for 10 seconds.
Return to the push-up position.
Step forward into a forward bend and hold.
Sit into a deep squat with open knees.
Lift hands overhead, stand up and bring arms back to your side.
Now repeat this on the opposite side: Bend forward at the hips to touch the fingers to the floor. Step into a stride position, extending the left leg (lunge). Lift the right arm – rotate the spine and the head – hold this pose for 10 seconds. Return to the stride position. Hands on right thigh, drop the back knee toward the floor and reach both arms overhead. Twist the torso toward flexed front knee and hold. Return to the hip flexor stretch position then put both hands on the floor. Go to push-up position. Sweep the right foot across in front – sit into the stretch and hold for 10 seconds. Return to the push-up position. Step forward into a forward bend and hold. Sit into a deep squat with open knees. Lift hands overhead, stand up and bring arms back to your side.
The shoulder is the key anatomical structure involved in every phase of the golf swing. If you’ve suffered a shoulder injury related to golf or are just looking to improve shoulder rotation and performance, ask your doctor of chiropractic about these exercises:
Wing stretch: Place the back of your right hand on the outside upper gluteal (buttock) region so the elbow sticks out to the side. The back of the hand touches above your “pants pocket” area. Grab the right elbow with the left hand and pull it the elbow forward, simultaneously resisting the pull by stabilizing your shoulder girdle backward on the stretching shoulder. Hold this stretch for one minute.
Open book: Lie on your left side with your knees bent and your arms straight out in front of you, palms together. Keeping your knees on the ground, take your top arm and rotate your upper body all the way in the opposite direction. Perform 15 reps. Repeat on the other side.
Thoracic rotation: Get down on all fours, place your right hand behind your head, and point your right elbow out to the side. Brace your core and rotate your right shoulder (think about moving through the shoulder blade) toward your left arm. Follow your elbow with your eyes as you reverse the movement until your right elbow points toward the ceiling. That’s one repetition. Do 20 reps right and left.
Band diagonal raise: Attach a band or handle to the low pulley of a cable station. Standing with your left side toward the pulley, grab the handle with your right hand in front of your left hip and bend your elbow slightly. Pull the handle up and across your body until your hand is over your head and your thumb is pointing up (a Statue of Liberty pose). Return to the starting position. Complete 10-15 reps and repeat with your left arm.
Scaption: Perform this exercise standing in front of a mirror to monitor their form. Hang the arms down by the thighs and rotate both hands to a thumbs-up position. Retract and depress the scapulae as you lift the arms up to shoulder-height at a 45-degree angle from the trunk. The arms should make a Y in front of them. Make sure that the upper trapezius isn’t pulling the shoulders into the ears. If it is, work on pulling the shoulders down in order to push the arms up. Perform two sets of 15 reps per set.
Lie face down on a bench with your upper shoulders off the bench to perform these exercises, which involve raising the arms / shoulders to mimic the shape of a Y, T, W and L (e.g., arms up over the head forms a Y; arms straight out to the sides forms a T; etc.). Standing Y-T-W-L exercises can also be performed using a stretch strap, which allows you to maintain a consistent arm position.
One More Great Exercise:
If you’re suffering from increased thoracic kyphosis (rounded upper back / shoulders), protracted shoulder blades and/or forward chin position, ask your doctor of chiropractic about this corrective exercise: Stand, feet together, looking straight ahead. The feet should remain in this position for the duration of the exercise. Put one hand beneath your collarbone and one hand on your belly button. Keeping your hands in that position, lift the chest with the hand under the collarbone while simultaneously pulling down with the belly button hand. This will help to lengthen the spine and reduce the slouched position. Holding the achieved position, level the pelvis by raising the middle of the pelvis with the lower abdominals. Lengthen the neck by slightly tucking the chin and imagining the crown of the head is being pulled toward the sky. Bend your knees very slightly, just enough to remove any tension from the posterior knee. Holding the achieved position, lean forward slightly to shift the center of gravity to the midfoot instead of the heel. Practice this frequently to improve posture. This opens the chest and allows for more natural breathing as well. While non-golfers may not realize it, the physical challenge of golf can be more daunting than the mental part of the game, particularly if you don’t use proper mechanics during every part of the swing. Injuries are common, which will either affect your game dramatically or stop you from playing altogether.
Talk to your chiropractor about these and other exercise strategies to improve your golf game and avoid injury. ——————————————————————————– Jeffrey Tucker, DC, is a rehabilitation specialist who integrates chiropractic, exercise and nutrition into his practice in West Los Angeles. He is also a speaker for Performance Health/Thera-Band, NASM and FMS.com .
Keep assessing globally and aim to find the key link.
That said, some of the patterns that have worked require more optimal core integrity….essentially normalizing the core. Not muscle specific but an adequate and appropriate balance of activity based on the load or demand placed on the system. Proximal stability (maintenance of expiratory position and cylindrical core activation) in the presence of distal mobility (extension movement of the hip)
Kneeling ball rollout
Push up variations
Once saggital stabilization is established, rotation moments are then assessed and challenged.
Make sure the T-L junction has good motion and that there is no, and I mean zero malposition of the pelvis. Rule out any tight hamstring issues or anterior pelvic tilt from tight quads, which either way leads to chronic shortness of the iliopsoas. Iliopsoas has a huge number of attachments in the trunk to flex the hip without falling over, but when short, in standing, it pulls the lumbar and last thoracic vertebrae forward and down. Look at the whole ribcage - take your finger and palpate between every rib and find active intercostal trigger points. No one hardly ever does this for clients…a lot is missing in between those ribs related to Tsp.
You get my point – keep looking globally, work locally at the T-L junction, the intercostals, more psoas. Maybe the hamstrings and quads. Make sure the person learns what a stable pelvis feels like and facilitate/strengthen muscles to keep it there.
PS. I have good news. I was invited to teach in Brazil on Nov 10-13.
Posted by DrTucker in Daily Exercises, Fitness & Exercise, Rehab Exercises on 10 21st, 2011 | no responses
Posted by DrTucker in Balance training, Blog, Daily Exercises, Rehab Exercises on 09 2nd, 2011 | no responses
One-leg hops on the spot: Two sets of 40 secs on each leg.
- Stand in a relaxed position, with your full body weight supported on your left foot only.
- Lift your left heel slightly, so that the force of body weight is passing through the ball of the left foot (your right knee is flexed so that your right knee is off the ground).
- Then, hop rapidly on your left foot at a cadence of 2.5 to 3 hops per second (25 to 30 foot contacts per 10secs) for the prescribed time period, while maintaining relaxed, upright posture.
- Your left foot should strike the ground in the area of the mid-foot and spring upwards rapidly, as though it were contacting a very hot burner on a stove. Your hips should remain fairly level as you do this; try to minimise vertical displacement of the upper body.
The Sacroiliac Joint (SIJ) does need to move during normal daily activities such as walking and running.
Movement in the SIJ and symphysis pubis is made possible by the fibrocartaligenous structure of these joints. It is both necessary and desirable that they move, so that they can act as shock absorbers between the lower limbs and spine, and to act as a proprioceptive feedback mechanism for coordinated movement and control between trunk and lower limbs.
As the SIJ is capable of some movement, this must be controlled for effective force transfer to take place between trunk and lower limbs.
Force Closure & Form Closure
The concept of force closure relates to the ability of a muscle system, through its attachment into connective tissue (ligaments and fascia), to compress two joint surfaces together and provide stability.
This is in contrast to ‘form closure’, in which the combination of joint structures (eg congruency or architecture) and related ligaments provide passive joint stability. To the therapist and trainer, ‘force closure’ is of greater interest because we can influence this through exercise and retraining.
Posterior oblique sling: consists of the superficial fibres of the latissimus dorsi blending with the superficial fibres of the contralateral gluteus maximus through the posterior layer of the thoraco-lumbar fascia. The superficial gluteus maximus then blends with the superficial fascia lata of the thigh, in particular the superficial iliotibial band (ITB). This sling system runs at a right angle to the joint plane of the SIJ and in effect will cause closure of the joint when the latissimus and contralateral gluteus maximus contract. Furthermore, the gluteus maximus and thoracolumbar fascia have investments into the sacrotuberous ligament. Tension in this ligament will also cause closure of the SIJ.
Anterior oblique sling: consists of the external oblique, internal oblique and the transversus abdominis via the rectus sheath, blending with the contralateral adductor muscles via the adductor-abdominal fascia. This will cause force closure of the symphysis pubis when contracted.
Posterior longitudinal sling: consists of the deep multifidus attaching to the sacrum with the deep layer of the thoracolumbar fascia, blending with the long dorsal sacroiliac joint ligament and continuing on into the sacrotuberous ligament. In a proportion of the population, the sacrotuberous ligament extends on to the biceps femoris muscle. This causes compression of the L5/S1 joint and compression of the SIJ.
Training the myofascial slings
The key principles apply as follows:
- The exercise is performed standing up.
- There is slight knee and hip flexion. This will pre-tense the gluteus maximus and quadriceps. This is necessary to activate the tension mechanisms in these muscles in order to stabilise the distal element of the posterior oblique sling. The close relationship of quadriceps to the fascia lata of the thigh allows tension to develop in the superficial ITB.
- There is slight forward lean with anterior pelvic tilt. This activates the deep multifidus, a component of the posterior longitudinal sling. Flexion of the hip in the form of partial squat also activates the hamstring muscles, another part of the posterior longitudinal sling.
- There is trunk rotation against resistance. This activates the oblique muscles, part of the anterior oblique sling. The rectus must be isometrically contracted to allow the lateral bands of the rectus sheath to provide a stable base for the obliques to work from. It is also important that the participant understands how to activate the transversus abdominis in the form of a hollowing action, to allow pre-tension in the thoracolumbar fascia.
- A broomstick sits on the shoulders. Pulling the broomstick into the shoulders allows isometric latissimus dorsi contraction. A stable closed chain system is then created for the posterior oblique sling to work effectively.
How to perform the exercise
This exercise was originally developed at the Australian Institute of Sport in Canberra. Tape or otherwise fix the resistance bands firmly to the broomstick.
As a yardstick, an appropriate level of resistance (band strength and length) should allow the client to perform 3 sets x 10 reps without great difficulty. Progress from there.
As a therapist, follow a good demonstration with good instruction. Verbalise the following points and cues:
- Keep quadriceps and glutes tight.
- Keep transversus hollow and tense rectus abdominis.
- Don’t rotate the pelvis, just the trunk. If the athlete has trouble dissociating pelvis and trunk rotation, have them perch their buttocks on the back of the chair, which takes about 25% of their body weight through the ischial tuberosities. This will give them feedback and position awareness so they can learn to maintain a stable pelvic position.
- Maintain a slight arch in the lumbar spine.
- Keep looking straight ahead, do not allow the head to turn with trunk rotation.
- Keep broomstick firm on shoulders in order to keep latissimus dorsi activated.
Note: one full repetition of this exercise involves rotating from x degrees backward trunk rotation to x degree forward trunk rotation, and then returning to the backward start point.
- Use a single band.
- Move through a small range of rotation 10 degrees to 10 degrees each direction (total arc of 20 degrees).
- Perform three sets of 10 reps each direction (band at left, then band at right).
- Use two bands, one either side of the broomstick.
- Rotate through 20 degrees to 20 degrees.
- Perform three sets of 10 reps in each direction.
- Can double up number of bands (or more, and/or use tougher bands etc), depending on the athlete’s available rotation strength
- extend range of rotation up to 45 degrees to 45 degrees.
- Perform three sets of 10 reps in each direction.
- Place one foot on a step to increase the range of hip flexion. This is particularly effective for sports requiring stability in positions of hip flexion, eg rowing and cycling.
- Decrease the width of the base of support by adopting a lunge stride position.
Myofascial slings: further reading
- Lavignolle B, Vital J M, Senegas J et al (1983): An approach to the functional anatomy of the sacroiliac joints in vivo. Anatomica Clinica 5: 169-176.
- Richardson C A, Jull G A (1995): Muscle control-pain control. What exercise should you prescribe? Manual Therapy 1: 2-10.
- Pool-Goudzwaard A L, Vleeming A, Stoeckart R, Snijders C J and Mens J M A (1998): Insufficient lumbopelvic stability: a clinical, anatomical and biomechanical approach to ‘a-specific’ low back pain. Manual Therapy 3(1): 12-20.
- Vleeming A, Stoeckart R, Volkers A C W, Snijders C A (1990a): Relation between form and function in the sacroiliac joint. Part 1: Clinical anatomical concepts. Spine 15(2): 130-132.
- Vleeming A, Volkers A C W, Snijders C A Stoeckart R (1990b): Relation between form and function in the sacroiliac joint. Part 2: Biomechanical concepts. Spine 15(2): 133-136.